Results of Cardiac Surgery in Advanced Liver Cirrhosis

PURPOSE: Cardiac surgery for the patients with advanced liver cirrhosis is still challenging. High mortality has been reported in the literature. We evaluate the clinical outcome of cardiac surgery in patients with advanced liver cirrhosis.

METHODS: Patients with advanced liver cirrhosis who underwent cardiac surgery between October 1999 and April 2009 were reviewed. The severity of liver cirrhosis was assessed using Child-Pugh class, Child-Pugh score, and MELD score. Advanced liver cirrhosis was defined as Child-Pugh class B or C. Cardiopulmonary bypass (CPB) was carried out at higher flow rate (2.4-3.2 L/min/m(2)), and hematocrit (25-30 %). Moderate and more tricuspid regurgitation were aggressively treated. Dilutional ultrafiltration was performed at the termination of CPB.

RESULTS: Eighteen patients (mean age 70 years, male:female = 14:4) were identified. Twelve patients had hepatitis virus infection and 6 cases were alcohol-related. Fourteen patients were graded as Child-Pugh class B and 4 in class C. Seventeen patients underwent cardiac surgery with the use of cardiopulmonary bypass, and 1 patient underwent off-pump coronary artery bypass surgery. The overall mortality rate was 17 % (3 of 18). The cause of death was liver failure, esophageal variceal bleeding and bacteremia. The mortality of redo surgery was high (50 %). The incidence of postoperative liver failure was 11 % (2 of 18). Child-Pugh class or score was not correlated with hospital mortality. MELD score was significantly higher in hospital mortality (10.8 ± 4.0 vs. 17.3 ± 2.1, p = 0.001).

CONCLUSIONS: Although the mortality of redo surgery was high, cardiac surgery could be safely performed in selected patients with advanced liver cirrhosis.